Long-term health
HRT and bone health, the long view
Oestrogen does quiet, important work for the skeleton. Why bone density matters in midlife, and how HRT fits into a broader plan.
Sukhy Uppal · 14 February 2026 · 7 min read
Oestrogen is one of the body's most reliable bone-protectors. When it falls in menopause, bone is lost faster than it is built, and the risk of osteoporosis and fracture rises. The good news is that this is one of the most treatable parts of menopause.
What the evidence says
Multiple large studies have shown that HRT, started around the time of menopause, slows bone loss and reduces fracture risk at the hip and spine. The earlier the conversation, the more the body has to gain.
What else helps
- Resistance training two or three times a week
- Adequate protein, around 1g per kg of body weight
- Vitamin D, particularly through the British winter
- Calcium from food where possible, supplements where not
- Less alcohol, no smoking
When to ask about a DEXA scan
If there is a family history of osteoporosis, an early menopause, long-term steroid use, or a previous low-trauma fracture, ask about bone density imaging at your review. Knowing the baseline makes every later decision easier.
